tv [untitled] January 31, 2011 1:30am-2:00am PST
the affected part and not blocking it off entirely. if you blocked it off entirely what is that called? a turn kit and we try not to us the t word in disaster medicine and tiewrn kits are -- turn kit are too often used by the publi and elevate the pressure point before you think about that. what is this patient suffering from? >> (inaudible) a little bit too much maker up an make up and we shock. and there is little phrase here comfort and reassurance and
victims don't care what you kn know. they just want to know that you care. i am going to be busy. and doctors and emergency personnel are busy and they don't have time to comfortable people, and lives can be saved by the vej len vigilence of unt personnel and you are there wit a family member and sit with a person and pat a hand, and mop fevered bra and these are important things that volunteer can do. shock. what is shock? it's the inadequate profusion o the body's cells that can lead to not enough oxygen in the brain and the brain needs two things to work. oxygen and sugar and if you run out of one the brain cells begi to die and if blood is not
getting up there you're not getting either one of those. how many of you have seen someone faint? they get bad news or cut their foot and did you need a doctor to tell you there is something wrong with the person? and you don't need to be a pro- and when someone is facing that shock and facin face fainting i way of telling you to lie down and signs and symptoms of shock confusion. disoriented, unconscious and skin pale and moist and pulse rapid and you have a problem here and you are nausea and thirsty or you can be thirsty and then nausea and here is a bottle of water and then they
get nausea and they throw up an they're having trouble and they go unconscious and throw up. not so good. people die that way. the rule is nothing by mouth in the prehospital field and nothing by mouth and the treatment for shock is remarkably simple. lay them down and raise the fee about a foot and keep them warm and they're chilly and the brai doesn't feel it and they will feel cold and you want to keep them warm. your patient is never shiver an first thing is always seeing safety and don't go rushing in and be cautious when you
approach them. norm, are you all right? if i can't tell he is breathing and i get closer and norm, are you all right? give him a shake. are you okay? if there is no response then yo have to look, wait a minute is he breathing? if he has a filing cabinet on top of him or covered with debris and maybe you can pull some of it away and evaluate hi breathing and put him in a tru traneutral position and neck injuries are rare and they are very dangerous but very rare an besides if you're not breathing what are you? >> (inaudible). >> so what you do is move them gently, and we're not trained and what you do is move them
gently and using common sense a individual and role on back and look, listen and feel and not breathing and i better open his air way and push down on the forehead and notch under here and you lift up and this will open the air way. now, this position and especially on a flat surface is a little uncomfortable and he's not going to stay in this position, so since you're nert people and you always work in teams and you always have your manual with you and two or thre manuals and slide them under hi shoulders, or you could take a shoe off and put it under the shoulders and make its so the head flops back a little bit an keeps the air way open and whil you attend to this and he's
bleeding and not breathing and now he's bleeding. so direct pressure. still bleeding -- put another dressing on and you can hold it in place with a bandage and if he wakes up hold on to this or you're going to die. he tends to hold on nice and tight and it's still bleeding. well, let's find this pulse point in here and we will push against the bone there and it will slow the blood and it's al good and bleeding stopped and hold on to that for a while and make sure the bleeding doesn't reoccur, and this guy ought toe a doctor and it's real bad and in fact we can tell him to see doctor and he has sweat and be
beading up on the forehead and looking pale and what do we do for someone who is pale and not responding well? what you want to do is raise hi feet about a foot and you can get creative about how you do i and you need something under th feet and take a chair on its side or take the shoes off and under there and take the bags lies around here and stick it under the legs and so the blood will flow out of the legs and t the mush where he needs it. >> okay. now that you know how to treat patients and what i am going to talk about is something called triage and it's going to tell you who to treat and we're goin to sort patients and when you sort patients and one of the things people don't understand and it's different than treatin patients and you have to trea t
them first and you know what yo have and then you can treat the with what you learned in the first half with steve and the goal of triage happens to be th motto of nert "do the most good for the most people" and if there is an earthquake right no and ceiling collapsed and 40 people in here, and if i'm the one rescuer coming to you and the first person is not breathing and no pulse, would you want me to stop and do cpr for this person before i reache you and what if there are 500 people behind that and do cpr and i just have to open an air way and all patients fall unde
under -- and i'm going to use colors and green, walking wounded and anybody that walks. d for delayed or yellow meaning you're hurt but you're not hurt enough. you're not hurt but that no not that bad an. and d is dead. and dead is the easiest one to determine. and how do we determine whether someone is dead? they're not breathing, right an steve said that several times and how do we know someone is not breathing? we look, listen, and feel and open the air way and we look to see if the chest is rising and listen to feel air and how long do we check for actually?
american red cross o says about ten seconds and if they are not breathing we readjust the air way and check for ten seconds again and not breathing for the secretarsecond time we said say and you check the air ways twic and when you know someone is dead you move on. let's go through the categories. walking wounded and anybody tha follows directions and get up and walk and it's green. d is delayed and anybody that i injured but we don't think it's life-threatening. i is the people that need treatment right now and d is th dead and black and during triag you open an air way and how lon does that take?
two seconds and it takes ten seconds to check and bleeding - the only bleeding i want you to treat during triage are arteria bleeding and spurting out and you could bleed to death in about three minutes and shock and if the person is unconsciou on the chair and how do i treat for shock? lay down and lift the feet and cover you and takes ten -15 seconds and i move on. the categories, black for peopl that are dead and green people that are walking and the only two categories left are red and yellow. this rule here that i'm going t teach you now and i want you to memorize it and this is the rul that is going to determine whether you're red or you're yellow. the rule is 32 can do.
i want everybody to say it with me. thirty-two can do. it's a three part rule. thirty, first part and 30 is respiration and it's the amount respirations per minute and if someone is breathing faster tha 30 times per minutes and it's about a breath every two second and if i breathe like this. that's about faster than 30 right? and if you have a patient breathing 30 seconds and they fail and tag them red and you move on. if someone is breathing normal than you go to the next rule. they pass and if go to the next rule. thirty-two is blood -- also ca called capillary refill and the
blarch test and capillary refil and look ata palm of your hand or fingertips and the nail beds are usually pink and if you squeeze and do it on yourself right now and squeeze your finger and it turns right and when you let go the pink return and i hope everybody in the roo i hope the pink returns in two seconds and if the pink comes back in two seconds you pass an if it takes longer you fail and you tag red and move on to the next patient and we have two rules. thirty and breathing faster and they fail and blarch test faste than two seconds and fail and can do and if someone can follo simple commands. look at me. tell me your name.
give me your hand. and if they can follow simple commands they pass. if i say "look at me" and they're not looking at me and "tell me your name" and they don't do anything "give me your hand" and they do something else they fail and tag them red and to the next patient and thi is the one of the hardest thing to grasp is how to triage and green, anybody that walks and blad and dead an -- dead and bl twice and red if you fail and either of the three parts of th rule. thirty-two can do. we're going to try this right now.
okay we will stop here because think we get the point. who are the first patients you came into contact with? and you were tagged yellow. and you tagged yellow because? >> (inaudible). >> and she was breathing less than third 30? follow commands and tagged yellow and it was tagged corre correctly. what was your deal? >> (inaudible). >> and you tagged her red. >> i caught up in the fact she was bleeding profusely. >> and walking and would you talk her? >> green this is the weird one and i should have gotten to you last and she is green because she is walking.
very good. this patient. >> (inaudible). >> very good. >> we tagged red. >> because? >> not responding -- >> very good and tagged red correctly. triage and i hope you guys can do it and 32 can do and divide the reds and the yellows and th greens are walking wounded and blacks are dead and simple as that and how long should you be with a patient? not more than 15 seconds and ho long does it take to check breathing? and you know right away and couple seconds to ask for a command and 22nds to check this and 15 seconds with a patient at the most and common injuries are brucing bruising, lacerations and sprains and si
signs and symptoms that you wil see is pain, di discoloration, e deformity and some of the treatments and you want to see the wounds and see blood and ri open the shirt so you can treat it and you see blood here and rip the shirt open and the bloo is from somewhere else and i immobilize them and someone has an object and never remove it and it's embedded and if you pull it out you could call caus bleeding and burns and three types and first, second, third degree and first sun burn and second and third is charring an treating burns and remove the heat source and of course it's smoking and cool it off and the cover the person and our skin helps keep our heat in and once
we lose the skin and now we are concerned with hypothermia and getting too cold and make sure whatever is burning is not burning anymore and the rules are keep it clean and them them warm and don't forget the air way, breathing, and shock and whatever you do know your limit and what you are capabilit capa once you are involved with the nert teams and you get to revie the stuff and what you can do and physically you know what yo can do and lift people and mentally is another thing and w will talk about disaster psychology next week and some people say they can't look at blood or some say they can't look at a child screaming and know your limits and don't
become a victim yourself. . >> we're going to go over search and rescue in this class, go over some buildings and how you assess buildings. you already had classes on utility controls, correct? how about medical? did medical? okay, as i said, my name is alec, i'm on truck 11. let's go into some light search and rescue. before you start, what do you do? stop, look, listen and think. any time you pull up to an incident or you see something, you take a breath, assess the situation, use all your senses and think about what you are going to do. those are all components of what we call the size-up. there are many components to size up. what's one of the components to
size up? gathering facts. you want to assess the type of damage there is. what kind of situation is it? what is the issue? is it a medical problem? if it's a medical, is it a big hurt or a little hurt? is it a rescue situation and if it's a fire, do you have the resources to control or extinguish that fire? how about your situation, do you have all your people? do you have all the resources that you need? have you collected all the material that you need if you are going to start doing a lifting exercise because someone is trapped? because you never start a rescue, you never start a lifting exercise, never start anything, unless you know you are going to be able to finish it, have enough of the resources to do it. and do you have the right equipment? you need specialized equipment? do you have access to that? maybe, maybe not. so size up, you want to establish your priorities, make your decisions. you want to come up with a plan and after you have a plan, you want to take action.
remember, it's continuous fact gathering process. you want to evaluate your progress. there are 50 percent of the people can be rescued by who? this is where you come in for the next 30 percent to make it 80 percent of the people. the next 30 percent of the people can be rescued by you people. then there's another 15 percent, that's where the fire department comes in, or the sheriff's department, people who are trained to do those type of rescue. the other 5 percent is by specialized teams, the usar teams. if you are to get to somebody within the first 30 minutes, they have a 99 percent chance -- a greater than 99 percent chance of surviving. get to them within the first day, it dropping down to 81 percent. still not bad. but what happens on the second day? plummets quite a bit, just under 34 percent. now you are always going to have your safety equipment with you, correct? when you get together as you
assemble, make sure you have, at least one person has something here that you guys can all use. different types of buildings are in the city. we have wood, unreinforced masonry, you have high rise and you have tilt ups. what's the safest construction type to be? four stories or less. wood? yeah, wood framed building. why is wood the safest building to be in, 4 stories or less? it flexes, yeah, it's flexible. what's the danger here? chimney, yeah, fireplace. be aware of the fact that just because it's a wood building and the event caused some sort of compromise of the structure of the building and the building is still standing doesn't necessarily mean there's not a danger there. so what could you as nert's do to make that situation better or at least keep it the same so no one else gets hurt? keep it off, yeah. keep people away.
perfect. take out some of that yellow tape that you have, that yellow caution tape, and string it around around keep people back. in this particular case, what could you do to make that situation better? turn off the gas. where would you turn the gas off at? at the street, okay. that's a good place to do it. but you always want to do it at the safest location. so if the street is the safest location, that's where you would do it at. this house here fell over. doesn't have something called a sheer wall. so it's just a platform or a platform or a balloon, nothing that keeps the wall from racking, they call it. so you want to make sure that the building that you are in are sheered. this is a connection between the plate, stud and the bottom plate. tie it all together. unreinforced masonry building. safe building or not such a safe building? not safe at all.
you have deep set windows, arched windows, metal plate, then we can work. weak morter, what is that? brick on top of brick on top of brick. there's an ample of the header row, you see how they are turned perpendicular to each other, you can see the header rows in this one, see the brick going the other way about every 5 or 7 rows. deep set windows. here's a close up of one of those plates. a parapet wall is a clue that this building is an unreinforced building. which direction can that building go? right back out. this building, brick or wood? what are some of the clues? okay, what are the windows? they are deep set. there's a clue right there. deep set. deep set window, unreinforced masonry. can you see the metal plates? there is a metal plate right over there in the corner,
there's another one over there. hard to see. also has a parapet on it. deep set windows. even though it has stucco on it, don't be fooled that that's wood up above. it's all brick because it's deep set windows. here we go with part of the roof and the parapet. this is over on (inaudible) street. see where the bricks fell, right on top of a car. there were 5 people in that car. buildings like this, you are nearest, where's the best place to be, do you think? you want to be far away from it? you want to be far away from it initially? yeah. but what if you are not far away from it when it starts happening, are you going to try to outrun it? no. you want to get up close to that building because the bricks have a tendency to fall out, fall straight down. if you'll notice right up next to the building there's not that many bricks. tilt up buildings, premade buildings. they are made on the site.
generally speaking, you see warehouses, large expanse buildings are made out of them, usually one story buildings. in other words there's not a story on top. they didn't make their corner connections very well. when they didn't make their corner connections very well, they moved independent, one side would go this way, one side would move that way, then the roof will fall down. how about high rises, are they safe buildings to be in? what happens in a high rise when there's ground movement? sways. yeah, it sways. where is most of this damage going to be to high rise buildings? because they are not going to fall down. they are on rollers, they are on springs, they are designed to withstand movement. but what about the stuff inside those buildings? so where's most of the damage going to be in those buildings? on the upper floors. so, high rise buildings different elements. you have structure and
non-structural elements. steel beams are structural but it's the contents, the stuff inside, that will hurt you. outside, steel going up, structural part. in this you can see if you take a look at it, they have the non-structural which is the brownish orangish area. that would be your dropped ceilings, your light fixtures, your hvac system. in this particular case, the alcoa building, the structural members are on the outside of the building. so you can see it right away. what's the danger with this building? glass. good. glass. so you have your typical office. what are some of the hazards here? remember, earthquake island, what are some of the hazards? the lights, glass windows, yeah, glass we already talked about, the bad things. how about all the book stuff?
building is still standing but everything else will fall right on top of you. bookcases, you want to secure those; right? this is what's going it happen. if you as nerts you went in there and got a report that there may be people trapped, where would you start looking for them? upper floors and void spaces. again, we talked about glass. are these people a little too close, do you think? did they give you a rule of thumb how far away to stay from buildings. well, actually 1 1/2 times the height of the building. so if you are in a 30-foot building -- you already did the math -- you want to be 45 feet away. glass falls out, too, do you think it just falls straight down? no, it kites its way around. it can kite up to two blocks away. be aware of that, got your helmet on. types of hazard, you have above ground, ground and below ground.
what's an above ground hazard? glass, wires, falling objects. some of the ground level hazards are glass. what's bad about uneven surfaces that are slippery? we already talked about that. you fall, you're going to hurt yourself. is water a bad thing to have? water seeks its own level, there's a hole, covering up the hole. you could be walking and all of a sudden down into a hole, correct? or a basement. water has weight to it, can cause damage to buildings, cause buildings to collapse. and it doesn't mix very well with electricity. below ground hazards, if you come up and you see a leak and the water is pouring out of a building, you know how to control it or try to control it? sure, you go right up to that utility shut off, turn it off. basements are bad places to be. there's usually only one way out and that's the way you went in. if that's compromised, y